Objective To summarize the best available evidence on radiation protection and management in the operating room and to provide an evidence-based reference for clinical practice. Methods Using the "6S" pyramid model of evidence, a systematic search was conducted in computerized clinical decision support systems, guideline repositories, professional society websites, and Chinese and English databases for literature related to radiation protection and management in the operating room. The search covered publications from database inception to November 2024. Three researchers who had received formal training in evidence-based practice performed quality appraisal, evidence extraction, synthesis, and grading. Results A total of 17 publications were included, comprising 4 clinical guidelines, 3 expert consensus reports, 6 systematic reviews, 2 evidence summaries, and 2 randomized controlled trials. Thirty-eight pieces of evidence were synthesized across four domains:basic radiation protection, radiation protective equipment, radiation dose monitoring, and radiation training. Conclusion The summarized best evidence on radiation protection and management in the operating room provides an evidence-based foundation for radiation safety management. It is recommended that the application of this evidence be adapted and translated according to specific clinical contexts to optimize occupational safety and practice standards.